Exclusive breastfeeding is the recommended nutritional source for infants up to six months of age (WHO, 2017.) Breast milk has properties that can promote health and prevent diseases in newborns. These properties found in breast milk can help decrease health costs by reducing the risk of certain illnesses in newborns. Even though studies have proven that breast milk has beneficial qualities, breastfeeding rates remain low (Lin, Chien, Tai, & Lee, 2008.) Many factors can influence this rate. Education, support, confidence, community, and the health care system can affect successful breastfeeding. Shu-Shan Lin, Li-Yin Chien, Chen-Jei Tai, and Ching-Fang Lee composed a research article regarding prenatal breastfeeding education. A critique of their study titled, “Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan” will follow.
Background of Study
In 2003, a national survey revealed low breastfeeding rates in exclusiveness and duration. Lin, Chien, Tai, and Lee recognized a knowledge deficit in this area as well as the need for improved breastfeeding in Taiwan. The authors recognize that in today’s society, breastfeeding is not automatic and may be intimidating for new mothers. Women perceive breastfeeding as a skill that needs to be obtained through education, preferably by healthcare professionals (Lin, Chien, Tai, & Lee, 2008.) Many hospitals in Taiwan provide prenatal education programs. However, the authors discovered that hospital based prenatal education programs varied across the nation. Findings included variations in class content, length of time, number of participants, and a lack of skills training. This study was designed to develop a prenatal education program and evaluate it’s effectiveness. Data was collected on breastfeeding knowledge, attitudes towards breastfeeding, satisfaction with the prenatal education program, breastfeeding problems, satisfaction with breastfeeding, and duration of breastfeeding to evaluate the effectiveness of program.
Methods of Study
This study followed a quasi-experimental design and was approved by the institutional review board at Taipei Veterans General Hospital (Lin, Chien, Tai, & Lee, 2008.) Participants were selected from a prenatal clinic in Taipei City. A total of 92 women participated in this study and provided their written informed consent. The experimental and control group consisted of 46 women in each group. Criteria for the study included women over 20 years of age who are married, first time mothers intending to breastfeed, are between 20 and 36 weeks gestation, and have had no complications throughout their pregnancy.
The women were asked to attend a 90 minute educational program on breastfeeding instructed by an experienced obstetric nurse who received specific, qualified, training. This program was designed after extensive literature review and was reviewed/modified by three experts. The program consisted of 50 minutes of lecture and skill training, a 20 minute tour of the postpartum unit, and 20 minutes of group discussion and skills practice. The tour introduced the women to the breastfeeding practices on the unit and allowed other women who were successfully breastfeeding to share their experience. The lecture aspect of the program focused on benefits of breastfeeding, it’s importance, lactation advice and best practices, nutritional requirements, breastfeeding and working, common misconceptions, and how to tell if their baby was getting enough. A powerpoint presentation and model breast and dolls were utilized. The skills portion included a demonstration of proper positioning and effective sucking. The forty six women who attended this program are the experimental group. Each of these women were matched to a control subject based on their age, education level, employment status, and gestation. Women in the control group did not receive any intervention. All women in the study received standard prenatal care.
Data Collection and Analysis
Data was collected during April, May, June, and July of 2003. Questionnaires regarding breastfeeding knowledge and attitudes on breastfeeding were utilized. These questionnaires were answered by all 92 women at recruitment. The experimental group was to repeat the questionnaire after the program which also included questions regarding their satisfaction with the teaching. A postpartum questionnaire was distributed to all 92 women three days after birth regarding their breastfeeding status, problems with breastfeeding, their knowledge, attitudes, and satisfaction with breastfeeding. This questionnaire was distributed to all women again at one month postpartum. The use of pre and post tests reduce the threat to validity (Grove, Gray, & Burns, 2015.)
The answers to the questionnaires were divided into categories then analyzed and scaled. Higher scores in categories indicated better knowledge and skills, better attitudes towards breastfeeding, high satisfaction towards education program, and high breastfeeding satisfaction. A high score in the breastfeeding problems category indicated more problems. Statistical Product and Service Solutions for Windows (SPSS) 12.0 and SAS 8.0 software was used for statistical analysis in this study (Lin, Chien, Tai, & Lee, 2008.)
Results of Study
The average age of the participants in this study was 31 years old. Since the women in the experimental group were matched with a control subject, age, education, and employment status were similar in both groups. Results from the pretest scores revealed no significant differences in breastfeeding knowledge. However, women in the experimental group scored higher at three days postpartum. With regards to breastfeeding attitudes, no great differences were noted in the pretest between both groups. At three days postpartum, the experimental group had remarkably higher attitude scores than the control group. No significant difference was seen in problems with breastfeeding between both groups at 3 days and one month postpartum. Data showed that women in the experimental group were significantly more satisfied with breastfeeding and had a higher rate of exclusive breastfeeding. The rate of exclusive breastfeeding was highest in the experimental group at three days postpartum and remained higher than the control group at one month postpartum. This study showed that a structured prenatal breastfeeding program is effective.
The participants were satisfied with the developed educational program. One area of interest was to increase the length of the class. The participants felt that the 20 minutes allotted to a group discussion was not enough time for all of their questions to be answered. A limitation of this study described by the authors was the lack of random assignment to experimental and control group status. Status of the groups were not concealed. Another limitation discussed were that all participants were from the same medical center. Compared to the national Taiwan population, the participants were older then the average reproductive age and had a higher educational level (Lin, Chien, Tai, & Lee, 2008.) To reduce bias, the instructor of the educational program was not involved in data collection. The identification of participants were kept confidential and private. Each participant received standard prenatal care and postnatal education to maintain ethical considerations.
Many factors play a role in a new mother’s ability to breastfeed successful. More prenatal patients are looking to healthcare professionals rather than friends and family to educate them and teach them breastfeeding skills. Closing the knowledge gap is crucial to increase breastfeeding rates and duration. Prenatal education is needed to increase breastfeeding knowledge, attitude and satisfaction. This study can help other hospitals plan, modify, or evaluate their prenatal educational programs.
Grove, S., Gray, J., & Burns, N. (2015). Understanding nursing research: Building an evidence- based practice (6th ed.). St. Louis, MO: Saunders.
Lin, S., Chien, L., Tai, C., & Lee, C. (2008). Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan. Journal Of Clinical Nursing, 17(3), 296-303.
WHO. (2017). Breastfeeding. Retrieved from www.who.int/topics/breastfeeding/en/
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